The Adolescent and the Aging Athlete

Stages of Life and Activity Levels  Birth to death continually changing, some good, some for maintenance some bad – happen to all as we grow and develop  Natural progression -  youth – growth and development  Young adult – maturation and adaptation  Final stages of regression in abilities and function As we age some activities not so simple any more, we are slower in reaction time, we fall more So how does age influence a rehab program

Trends in work and Leisure  People now have more leisure time than work time  Increase in the number of leisure activities and number of people participating  Different levels of skill and devotion to the activity  Economic background – sex  People are living longer and want to be active longer

Pediatric Considerations  Patients developmental stage and structure injured  Kids are not small adults  Can not be treated like adults with rehab programs, adjustments must be made with consideration of their physical and physiological maturity level  Growth and Development  Girls begin growth pattern earlier and end earlier ( approx. 2 years)  Puberty - girls 9 boys 11  Epiphyses close at 18 girls boys 20

Growth and Development  Bone factors  Damage to physis ( forms new bones ) can limit bone growth  Young bones more resilient and elastic than adult bones  Green stick fractures  Articular Cartage Factors  Subject to same stress as adults, but evidence suggests may heal better than adults  Active children may develop thicker cartilage than non active, leading to active children less lightly to develop OA  Muscle Factors  Girls and boys have same muscle proportions and strength prior to puberty  Post puberty muscle size and strength greater in boys  Strength training for preadolescents AAP 2001 guidelines and recommendations

Growth and development  Tendon Factors  Tendon applies increased tension on the apophyseal attachments  Repetitive stress injuries  Growth spurts  Osgood schlatters  Neurological Factors  Repetition of specific activity  Neural changes and neuromuscular recruitment improvements are responsible for strength gains in children prior to puberty  Thermoregulatory Factors  Children release heat differently ( do not sweat as well )  Heat released by convection ( red faced)

Adolescent Sport Participation  In USA ½ boys and ¼ girls engage in organized sports  Increased sport participation numbers = higher injury rates  Swimming  Jogging  Basketball  Volleyball  Weight training  Intrinsic/ extrinsic factors  Non-modifiable  Modifiable  Prevention

Common Injuries/ Conditions seen in Adolescent Athletes  Epiphyseal plate injury  Apophysitis  Fractures  Avulsion Fractures  Osgood- Schlatter’s  Tendon, sprains strains  Swimmer’s shoulder  Jumper’s knee  Gymnast’s back  Little League elbow  tendinitis

Bone & articular cartilage Rehab  Bone prevent additional injury  Bone heals quickly  Watch out for damage to growth plates – usually casted  Rehab gradual and progressive, generally looking to increase ROM, usually active are sufficient

Muscle and Tendon Rehab  High reps low weights  20 – 30 reps before increasing weight  Proper form crucial - supervision  incorporate rest

Neurological and Thermo Rehab  Pre pubescent - Will not increase muscle bulk but will make strength gains  Repetitions improves accuracy  Children look red faced after activity – this is normal  However extra care must be taken on hot /humid days – more breaks and water

Geriatric Considerations  Peak physical conditioning 20 – 30 years old  Reversal is slow process – so many years later we notice the decline in our abilities  Normal aging process –  As therapists we can not have the same expectations of our patients as we do with young patients  Remember many may be older than you.. The therapists.. but they may still feel young and energetic  They desire as much care and attention as our younger population

Physiological Considerations  Bodies Changes with Age  Peak at 20 – 1% loss a year 40 % loss by time 75 ( 40 – 50 years)  Some systems decline slower that others  Generally connective tissue becomes stiffer, affecting muscles, tendons and joints  Risk of injury is increased  Muscular Factors  Scaropenia – decreased muscle mass secondary to aging ( both size and number of muscle fibers )  15 % decrease each decade after age of % decrease  Speed and muscle endurance decrease as well  However size, speed and coordination will increase with exercises

Physiological Considerations  Skeletal Factors  Bones and joints – as we age less water in the cartilage, leading to increased joint stress  Thickness of cartilage decreases with age  Menopause – bone density decreases slowly at first and then more rapidly ( post menopausal ) – men bone density decreases as well  However bone strength can improve with weight bearing activities  Neural Factors  Balance, speed of movement decrease with age  Loss of hearing or sight, can effect balance but also hearing and reading instructions

Rehab considerations  Exercise a positive influence on the aging process  Older athletes may show less decline  For the aging population, cardio, muscle strength, balance, coordination, flexibility and endurance all can increase with regular exercises  Cardiovascular –  monitor heart rate – 220 – age 50 % a good start point, can work up to 80 % of max  Neuromuscular  Strength and endurance gains can be made, but slower  Agility much slower, caution advised  balance – single leg young 30 sec single leg, sec

Who is the Aging Athlete?  Middle Aged yrs old  Elderly  Populations 85 years plus are considered very old  Explosive population for the next several decades

Common Injuries for this Age Group  Subacromial bursitis  Adhesive capsulitis  Subacromial impingement syndrome  Trochanteric bursitis  Back pathology  Degenerative meniscal tears  Partial tears of the triceps surae  Post traumatic ankle instability  Plantar fasciitis

Other Concerns  Strength, flexibility, balance  Osteoporosis/ osteoarthritis

Rehabilitation Considerations  Initially more time may be needed for assessments  Hearing, comprehension  Larger font handouts  Similar rehabilitation can be given to aging athletes  Older pts compromised vascular supply – healing will take longer  Caution and slower progressions should be used  Warm-ups – cool downs  Weights – light  Stretching – avoid overstretching –slow and controlled  Balance – watch risk of falling withal exercises